Unhealthy lifestyles and low Life’s Essential 8 scores are associated with a higher risk of new-onset low back pain: a prospective cohort study

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BACKGROUND CONTEXT: Low back pain (LBP) is a major global public health concern. However, few large-scale prospective cohort studies have comprehensively examined the relationships among multiple modifiable lifestyle factors, cardiovascular health metrics, and LBP risk. PURPOSE: To investigate the associations between healthy lifestyle behaviors, Life's Essential 8 (LE8), and LBP incidence, and identify potentially optimal lifestyle patterns for LBP prevention. STUDY DESIGN/SETTING: Large-scale prospective cohort study based on the UK Biobank. PATIENT SAMPLE: This study included 140,313 participants. During follow-up, 10,036 individuals developed incident LBP, whereas 130,277 remained LBP-free. OUTCOME MEASURES: Seven lifestyle factors and 8 cardiovascular health (CVH) metrics were used to calculate lifestyle and LE8 scores. The associations among the overall lifestyle category (ideal, intermediate, and poor), LE8 category (high, moderate, and low CVH), individual lifestyle factors, and incident LBP were assessed. METHODS: Cox proportional hazards models examined the associations among lifestyle score, LE8 CVH score, and LBP risk. In addition, population attributable fractions and cumulative incidence were estimated and sensitivity analyses were performed. RESULTS: Over a median follow-up of 13.54 years, participants in the intermediate (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.05-1.21) or poor (HR: 1.25, 95% CI: 1.18-1.32) lifestyle categories exhibited significantly higher risks of developing LBP than those in the ideal lifestyle category. Similarly, compared with the high CVH group, individuals with moderate (HR: 1.06, 95% CI: 0.95-1.20) or low (HR: 1.28, 95% CI: 1.10-1.44) scores had elevated LBP risk. Adherence to an ideal lifestyle and maintaining a high CVH status may decrease the risk of incident LBP by 12.26% and 9.29%, respectively. Among the individual factors, prolonged sedentary time (12.62%), elevated body mass index (11.25%), unhealthy sleep patterns (7.01%), abnormal sleep duration (5.28%), current or former smoking (4.61%), insufficient physical activity (3.64%), and poor glycemic status (0.58%) independently associate with increased LBP risk. CONCLUSIONS: A poor lifestyle and low LE8 CVH scores are associated with a higher risk of new-onset LBP. Promoting healthy lifestyles and improved LE8 scores may help mitigate the burden of LBP.

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